Name:  Mr/Ms_____________________________________________
Address: _________________________________________________
City: _____________________________________  State: _________
Zip Code: _______________  Phone: __________________________

Favorite Program(s): ________________________________________

Are you a new listener?           Yes   No
Do you listen on the internet?   Yes    No

Comments:________________________________________________
________________________________________________________
________________________________________________________

Please check one of the following...
$20  WWUH Program Guide Subscription
$30  T-Shirt: Adult Sizes  S  M    L   XL   XXL
$30  Ambience "EUPHONY 1" Limited Edition CD
$40   Listener Kit: Guide Subscription & (1) T-Shirt [check size]
$100 Sustaining Member: Guide Subscription & (3) T-Shirts [check size]
$150 WWUH MicroFiber Jacket: Adult Sizes   M    L   XL   XXL
$250 Patron: Choice of any of above premiums [circle choice & size]
                           Plus your name in the 'WWUH Program Guide' for one year.

Payment: Donation Amount $__________________ 
                  Check    Master Card    Visa
         (Please make checks payable to: WWUH Radio)

Card Holder (Exactly as name appears on your card)

___________________________________________________________________

Card # ________________________________    Exp:______________